title: The effect of high temperatures on cause-specific mortality in England and Wales.
abstract: OBJECTIVE
  Several observational studies have suggested an association between high temperatures and all-cause mortality. However, estimates on more specific mortality outcomes are sparse, and frequently assessed in studies using different analytical methods.
  
  
  METHODS
  A time series analysis was performed on 10 regions in England and Wales during the summers (June-September) of 1993-2006. Average percentage linear increases in risk for a 1°C increase in temperature above region-specific thresholds and attributable deaths were computed by cause-specific mortality and age groups (0-64, 65-74, 75-84, 85+).
  
  
  RESULTS
  There was evidence of increased mortality with heat for almost all cause-of-death groups examined, with an overall increase in all-cause mortality of 2.1% (95% CI 1.6% to 2.6%) for a 1°C rise above the regional heat threshold. Among main causes, the steepest increase in risk was for respiratory mortality (+4.1% (3.5% to 4.8%) per 1°C). It was much smaller for cardiovascular causes (+1.8% (1.2% to 2.5%)) and myocardial infarction (+1.1% (0.7% to 1.5%)), but comparatively high for arrhythmias (+5.0% (3.2% to 6.9%)) and pulmonary heart disease (+8.3% (2.7% to 14.3%)). Among non- cardiorespiratory causes, the strongest effects were for genitourinary (+3.8% (2.9% to 4.7%)) and nervous system (+4.6% (3.7% to 5.4%)) disorders. 33.9% of heat deaths were attributable to cardiovascular causes, 24.7% to respiratory causes and 41.3% to all other causes combined.
  
  
  CONCLUSIONS
  These results suggest that the risk of heat-related mortality is distributed across a wide range of different causes, and that targeting of preventative actions based on pre-existing disease is unlikely to be efficient.
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. antonio.gasparrini@lshtm.ac.uk
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasparrini
authors.forename: Ben
authors.initials: B
authors.lastname: Armstrong
authors.forename: Sari
authors.initials: S
authors.lastname: Kovats
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000401:mortality; D012140:Respiratory Tract Diseases / Q000401:mortality; D014852:Wales / Q000453:epidemiology; D055815:Young Adult